This February, between the season’s last frost and the primary indicators of spring, we explored new analysis on healthcare affordability. This month we learn in regards to the pricing impacts of vertical consolidation, the first drivers behind the current surge in nationwide well being spending, and the persistent menace of medical debt for sufferers following acute accidents.
Strategic Choice And Pricing Energy: Optum’s Acquisitions Of Ambulatory Surgical procedure Facilities And Doctor Practices
Derek T. Lake et al.. Well being Affairs. February 2026. Out there right here.
Researchers from Cornell and Brown Universities analyzed Medicare and business claims information from 2013–2021 to guage how Optum’s acquisitions of doctor practices and ambulatory surgical procedure facilities (ASCs) influenced affected person referral patterns and facility pricing.
What it Finds:
- Optum preferentially acquired doctor practices that already had excessive charges of ASC use, which means the acquisitions didn’t trigger a big shift of sufferers from hospital outpatient departments to cheaper settings.
- The acquisition of 24 ambulatory surgical procedure facilities was related to an 11 p.c worth improve for procedures charged to competing business well being plans.
- This worth development was pushed by a mix of broad will increase in facility charges and an increase in skilled charges that occurred particularly amongst Optum-employed physicians.
- In markets the place Optum owned each the referring doctor observe and the surgical procedure heart, there was no proof that vertical integration led to improved cost-savings by means of “site-of-care” shifts, regardless of the potential for such incentives.
Why it Issues
This analysis challenges the narrative that vertical integration results in a extra environment friendly healthcare system. Whereas buying entities usually declare that their buy of doctor practices and surgical procedure facilities lowers prices by steering sufferers to cheaper websites of care, this examine demonstrates that these entities might as an alternative be cherry-picking already-efficient practices after which utilizing their elevated market energy to extend costs. The 11 p.c worth improve for competing insurers means that such consolidation can be utilized as a software to drawback rivals, which in the end drives up premiums for customers. Finally, the information recommend that transferring care to ambulatory settings will not be a cure-all for affordability if these settings are owned by dominant company entities.
Hospital Spending Accounted for 40% of the Progress in Nationwide Well being Spending Between 2022 and 2024
Jamie Godwin, Zachary Levinson, and Tricia Neuman. KFF. February 2026. Out there right here.
KFF researchers analyzed federal Nationwide Well being Expenditure (NHE) information from 2022 by means of 2024 to establish and examine the first drivers of development throughout numerous sectors of nationwide well being spending.
What it Finds:
- Hospital care was the first driver of nationwide well being spending development between 2022 and 2024, accounting for $277 billion (40 p.c) of the overall $692 billion improve in spending throughout that interval.
- Value will increase and a return to pre-pandemic utilization ranges for high-intensity providers have been cited because the main elements behind the surge in hospital expenditures.
- Whole nationwide well being spending reached $5.1 trillion in 2024, with a mean annual development charge of seven.3 p.c over the two-year interval, considerably outstripping the 5.2 p.c development seen within the general U.S. financial system.
- The contribution of hospital spending to whole development far exceeded different main classes, with doctor and medical providers accounting for $96 billion (14 p.c) and retail pharmaceuticals accounting for $88 billion (13 p.c) of the rise.
- Medical insurance administrative prices and income, together with authorities public well being actions, represented the second-largest share of development at 15 p.c, reflecting a “residual” class of spending that rose as pandemic-era packages wound down and personal market dynamics shifted.
Why it Issues:
Regardless of vital coverage deal with drug pricing and insurance coverage firm income, the hospital sector stays essentially the most substantial contributor to rising healthcare prices within the post-pandemic period. The truth that well being spending is rising at a quicker charge than the general financial system means that medical bills are consuming an ever-larger share of nationwide sources, which might crowd out different private and non-private priorities. This development is pushed not solely by a return to high-intensity care after years of deferred providers but additionally by persistent upward stress on the costs hospitals cost. For employers and customers, this shift interprets instantly into increased business insurance coverage premiums and elevated out-of-pocket prices.
Adjustments In Medical Debt And Chapter After Acute Traumatic Accidents, 2019-21
John W. Scott et al.. Well being Affairs. February 2026. Out there right here.
Researchers from the Universities of Washington and Michigan analyzed a statewide trauma registry linked to client credit score stories from 2019–21 to guage the influence of acute traumatic damage hospitalizations on medical debt and chapter filings.
What it Finds:
- At eighteen months post-injury, the proportion of sufferers with medical debt in collections elevated by 5.2 proportion factors, representing a 24 p.c relative improve in contrast with the pre-injury baseline.
- The common quantity of medical debt in collections per affected person rose by $290, which marks a 76 p.c relative improve from the degrees recorded earlier than the traumatic occasion.
- Submit-injury chapter filings peaked at fifteen months, reaching a charge of three.2 per 1,000 sufferers and representing a 6 p.c relative improve over the baseline.
- Monetary hardship disproportionately affected uninsured, youthful, and lower-income people, in addition to these with personal insurance coverage, whereas sufferers lined by Medicare and Medicaid skilled minimal adjustments of their monetary standing.
Why this Issues:
Even with the Reasonably priced Care Act’s protection beneficial properties, an unanticipated acute medical occasion can nonetheless trigger vital and lasting monetary instability for American households. The truth that privately insured sufferers noticed significant will increase in debt and chapter signifies that many business plan designs, characterised by excessive deductibles and cost-sharing, are failing to supply satisfactory monetary safety towards traumatic damage. These monetary shocks have an extended tail, with debt and chapter filings peaking greater than a yr after the preliminary damage, suggesting that the financial fallout persists lengthy after the medical restoration. The examine additionally exposes a stark distinction in safety throughout insurance coverage sorts, as these with Medicare and Medicaid have been largely shielded from monetary danger because of their extra beneficiant protection. These findings underscore that for a lot of People, significantly the privately insured, a single emergency stays a possible catalyst for long-term collections and credit score injury.
